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Background: Modeling can be a critical tool for HIV program planning, allowing users to estimate outcomes, such as HIV incidence, that are otherwise impossible to measure. In 2007, in light of evidence that voluntary medical male circumcision (VMMC) reduces HIV acquisition in men, WHO and UNAIDS prioritized 13 countries for rapid scale-up to 80% MC prevalence. Since then, models such as the Decision Maker''s Program Planning tool (DMPPT) and the DMPPT 2 have been used to describe the epidemiologic impact and cost associated with MC scale-up. The authors explore the influence of these models on VMMC policies and programs at country and global levels.
Description: In 2011, results from the DMPPT, a Microsoft-Excel-based modeling tool, demonstrated that VMMC scale-up would result in substantial reductions in HIV infection and lower health system costs. The analysis informed advocacy that led all priority countries to commit to reaching this goal, and was incorporated into the WHO-UNAIDS Joint Strategic Action Framework for VMMC in December 2011. In response to questions arising from implementation experience, a revised model (DMPPT 2) enabled analyses of impact and cost-effectiveness by age group and subnational region starting in 2013. Results were incorporated into operational and strategic plans in Tanzania, Malawi, Uganda, South Africa and Swaziland, and informed global guidance from PEPFAR and UNAIDS. A new version (DMPPT 2.1) allows countries to better monitor their progress by generating targets, assessing impacts to date, and disaggregating estimates by age and district. This information is critical to countries to move from scaling up VMMC to maintaining coverage levels, and to PEPFAR for Country Operational Planning.
Lessons learned: Modeling can be an effective tool for advocacy as well as strategic planning and monitoring. It is most useful when it is conducted in collaboration with country teams and addresses country-generated questions. Country ownership helps to ensure model results are incorporated into national strategies and implementation plans.
Conclusions/Next steps: Models can be used to mobilize, strategically implement, and monitor key programmatic elements in an HIV response. The ways in which modeling has informed VMMC programs and policy may be applicable to other HIV program areas and interventions.

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